Caring for Premature Babies: Cruel?

[dixieagle]

How could we possibly do organ transplants on premies? Where are those teeny-tiny organs going to come from? I am sure some scientists would love to start creating fetuses to use as organ farms! UGH!! This would be exactly the same situation we deplore when it comes to embryonic stem cell research.

You also mention “if the physicians think there is a reasonable chance for success”. In the example cited in the OP, the drs did NOT think there was a reasonable chance of success.

Let’s do the math here. A normal pregancy lasts about nine months or 38 weeks. Full term is considered anywhere from 38 to 42 weeks of pregnancy (counting from the last menstral cycle). A 20 week old baby is barely half way through his development! Did you notice that in the article, the nurse was actually counting days – 20 weeks 5/7 etc. Each day in the mother’s womb extends a baby’s chance of survival.

One question raised earlier is whether, in this particular case, the drs attempted to stop the mother’s labor. That would be a normal first step. We don’t know, but considering that she’d had 8 (?) previous miscarriges, it may be that they simply weren’t able to.

My heart goes out to the couple in this story and I have been praying for her and other parents of premies. However, I do agree with Dixieagle that “careful study of Catholic teaching with regard to ordinary/extraordinary means, and some simple common sense, are in order.” When we demand too much in the way of extraordinary means, we open science’s floodgates to some very ugly manipulations of the human being.

Thank you!!!

Before one gets worked up into a lather, it makes sense to actually arm oneself with facts and Church teaching, rather than simply relying on emotion. You have done that admirably.

 

[larsenl1]

I was born at 30 weeks long enough ago that at that time, my parents were told I simply could not possibly survive. When, months later, I was discharged from the hospital, they were told I would be severely retarded and it was recommended I be institutionalized.

There will always be a “current” stage considered “too premature to survive” and we must recognize this is a temporary distinction - the threshold will inevitably continue to change.

hmmm, askseekknock, you have had quite a life, born premature, drs wanted to let you die, you survived, you are not retarded. Wonderful.

Then you were baptised Catholic and received first communion but was not confirmed. As an adult you publicly pledged your loyalty to another denomination and were married a protestant and you are seeking advice on the moral theology forum about how to re-join the Catholic Church.

You have managed to hit 2 hot buttons in your life. I am beginning to think you are trolling the forums and trying to rile people up. Shame on you.

 

[Timbothefiveth]

While not all suffering is necessarily bad I think we need to ask ourselves is there a point to the suffering. And who are we really doing a favor for here? I mean can you say that putting a 21-22 week old premie through likely tortorous procedures that will likely just mean a longer more prolonged more painfilled death is doing them a favor?

I’m not a doctor, but I’d think they could give them painkiller.

And once again, if you were shot and had a 10% chance of surviving, would you want the hospital to just say you aren’t worth it?

 

[Holly3278]

I think that to deny care to any living human being that has the possibility to be saved is itself very cruel.

Some medical treatments are awful (chemotherapy, interferon treatments, etc…) but if it means saving the life of an ill patient, why not? Morality aside, how could parents let a child slip away without knowing that htey did all they could to save its life? Could anyone live with themselves after that?

I totally agree. It is very cruel to deny care to any living human being.

 

[Calliso]

I’m not a doctor, but I’d think they could give them painkiller.

And once again, if you were shot and had a 10% chance of surviving, would you want the hospital to just say you aren’t worth it?

The thing is from what I have been reading…sometimes painkillers and other drugs just wonlt work on them…or they could kill them. As for the gunshot thing as DOshea pointed out earlier that;s not really a good comparison to treating a 21 week old premie. So yes I would want the doctors to treat me for the gunshot thing. However if I was in a situation more like what DOshea decribed no I would not want the doctors to treat me.

 

[dixieagle]

I totally agree. It is very cruel to deny care to any living human being.

The question is…what kind of care? Palliative care? Or extreme measures, pulling out all the stops. We are speaking of 21-22 week preemies here, to stay on topic.

It might be wise to do a little research on the realities faced by a baby born that early.

 

[centurionguard]

Could someone enlighten me on the Americanized abbreviation between Natal Intensive Care Unit and the Neuro Intensive Care Unit ? Are they both abbreviated as N.I.C.U. ?
I assume it’s the same in Canada. Sorry for the fuss confusion.

 

[Ceil-1]

Neonatal intensive care unit.

 

[Newbie2]

How could we possibly do organ transplants on premies? Where are those teeny-tiny organs going to come from? I am sure some scientists would love to start creating fetuses to use as organ farms! UGH!! This would be exactly the same situation we deplore when it comes to embryonic stem cell research.

Perhaps adult stem cells could provide a source for accelerated development of those organs. 50 years ago, organ transplants were in the realm of science fiction. They are common nowadays. Do not make the mistake of dissing a medical posibility because the technology to perform such a procedure does not yet exist.

You also mention “if the physicians think there is a reasonable chance for success”. In the example cited in the OP, the drs did NOT think there was a reasonable chance of success.

Of course, if the physicians do not hold out a reasonable chance of success, such measures are likely to be considered extreme and prolonging the life of the baby would not be a moral requirement. In that case, palliative care would be best.

Let’s do the math here. A normal pregancy lasts about nine months or 38 weeks. Full term is considered anywhere from 38 to 42 weeks of pregnancy (counting from the last menstral cycle). A 20 week old baby is barely half way through his development! Did you notice that in the article, the nurse was actually counting days – 20 weeks 5/7 etc. Each day in the mother’s womb extends a baby’s chance of survival.

Yep.

One question raised earlier is whether, in this particular case, the drs attempted to stop the mother’s labor. That would be a normal first step. We don’t know, but considering that she’d had 8 (?) previous miscarriges, it may be that they simply weren’t able to.

My heart goes out to the couple in this story and I have been praying for her and other parents of premies. However, I do agree with Dixieagle that “careful study of Catholic teaching with regard to ordinary/extraordinary means, and some simple common sense, are in order.” When we demand too much in the way of extraordinary means, we open science’s floodgates to some very ugly manipulations of the human being.

Yet, if we do not push the envelope, advances in medicine will not be made, at least not as quickly. I agree that there must be balance.

You have clearly missed my point completely. Obviously there have been enormous breakthroughs in preemie care. However, the reality is that there is a threshold beneath which even the best intentions won’t save a micropreemie whose organ systems aren’t developed enough, and have no hope of developing outside the womb (about 21-22 weeks.)

Yes, at the present time. My point is that although we may not be there yet, medical technology available 30 years from now may make us laugh at our “stone age” technology we have at present.

I don’t really think that, were a tiny set of infant lungs available for transplant, that it would go to a micropreemie, but rather to another infant who is more developed and with a better chance of survival (but this is all fanciful anyways.)

Given the limited availability of any transplant organ, that should be the case, yes.

If you real my previous posts, you will notice that I have already alluded to a future in which some “womb-like” atmosphere may be developed that would assist these tiniest ones to developed enough to survive. There has actually been research done on this, but it has proven to be far more complicated than thought. shine.yahoo.com/channel/parenting/what-happened-to-the-artificial-womb-471959/

Yep, the human body is way more complicated than many medical “experts” would even realize.
Again, you miss the point. Ongoing research means that there is always hope a particular cure is around the corner. However, adult patients, at least, have the capacity to decide whether they wish to pursue often difficult treatment or not. You simply cannot compare a cancer patient, who has already-developed organ systems, with a 21 week micropreemie.

Not in terms of their medical needs, of course not. But in terms of access to the best health technology available, there is a similarity…

The point is that in the 21-22 week preemies that are the actual topic of discussion, there is NOT a reasonable chance for success. Read the posts!!!

Please don’t lecture me, pal, I have read the posts. My point is that at this point in time, there may not be a reasonable chance for success. So, we can do two things. Throw our hands up and give up or try our best to improve the chances for these and possibly, in the future, even younger preemies.

Again, the difference is that the baby is older, with lungs that are developed, etc. Clearly, if there is an open-heart procedure that has a reasonable chance for success, physicians and parents will and should opt for it.

Right, and not too many years ago such a procedure was unthinkable.

If one is going to get all in a dither, then at least be sure you understand what a poster has actually said. Also, creating fanciful straw man arguments doesn’t contribute to the discussion.

So don’t create any fanciful straw men. Take your own advice.

 

[dixieagle]

Please don’t lecture me, pal, I have read the posts. My point is that at this point in time, there may not be a reasonable chance for success. So, we can do two things. Throw our hands up and give up or try our best to improve the chances for these and possibly, in the future, even younger preemies.)

First, I am in not your “pal”, but a 57 year old mother.

The entire thrust of this thread is what should be done NOW with a 21-22 week micropreemie. No one has suggested that research should not continue. However, due to the problems presented by underdeveloped lungs, etc., beneath a certain threshold the only way that even tinier babies might, in the future, survive, would be through technology that would bring with it its own set of ethical dilemmas.

We must ask ourselves the question: “Are we really meant to preserve every life, at whatever cost? Or, as Christians, are we to do what is reasonable and charitable, but know that this is not the life for which we are ultimately destined?”

 

[DOShea]

I’m not a doctor, but I’d think they could give them painkiller.

They do wherever it is warranted; the problem is, the baby’s body doesn’t react to the drugs in the same way a fully developed baby would. Many of the bodily systems and functions we think of in terms of the human body just are not present. If you administer a painkiller that deadens the response of neuroreceptors, that does little good to a fetus that doesn’t have all their neuroreceptors and the chemistry systems to support them in place. Or one who’s liver/kidneys cannot withstand the toxicity of compounds formed when the drug enters the bloodstream.

Here is another example that I came to be aware of from the work of a research team that conducted some clinical tests in the NICU where my wife worked. In a fully developed human being, there are two mechanisms that allow us to breathe without conscious effort to do so. First, there is a center of the brain that “measures” (I’m using loose terminology here) the amount of oxygen in the blood flow to the brain. When it drops below a certain point, it triggers responses to muscles, diaphragm, etc. to make us take a breath. Now we can override this system if consciously trying to, such as when we swim underwater some distance. There is a second center of the brain, independent of the first, that “measures” carbon dioxide levels in the blood. This serves as the “back up” for method number 1, and this normally cannot be overridden consciously, though with specific practice it can be.

When these systems develop in a fetus, the second means develops first. That is, the carbon dioxide “sensor” develops first, some weeks before the “oxygen” sensor does. Additionally, it develops with a special characteristic that we lose somewhere in our development. That is, if the CO2 sensor causes the breath, it also shuts down, temporarily, the ability of the brain to absorb oxygen out of the blood, apparently to protect against further carbon dioxide saturation. That would mean the baby would breathe, but there would be a short delay, until the oxygenated blood actually got to the brain’s sensor and it accepted the level of CO2 as low enough to proceed, it then activates the brain’s ability to absorb gas out of the blood. I don’t know if other organs are effected in a like manner, this was just dealing with the brain.

So here is the problem. Baby is born premature, and can breathe with the “CO2” sensor only. But the baby’s lungs are so undeveloped, it has to be respirated, meaning supplied oxygen (and no CO2) by artificial means. Without some CO2, this sensor can go haywire and cause the brain to, for short periods, stop absorbing oxygen. I don’t think I need to explain what happens when brain cells get no oxygen.

What this group was searching for is the “switch” that can reliably turn brain oxygen absorption on and keep it on during this temporary, premature state.

This is just one example of how the treatment of premature babies can be the best care the world can muster, the budget can be a blank check, but unless the developing cells of that tiny little brain cooperates, it can all be for nothing.

 

[Newbie2]

First, I am in not your “pal”, but a 57 year old mother.

My bad. But you get the point, no?

The entire thrust of this thread is what should be done NOW with a 21-22 week micropreemie.

Yet, what we do now gives us helpful information on what works and what doesn’t and is helpful for the future.

No one has suggested that research should not continue. However, due to the problems presented by underdeveloped lungs, etc., beneath a certain threshold the only way that even tinier babies might, in the future, survive, would be through technology that would bring with it its own set of ethical dilemmas.

Why would the dilemma be any different? We have difficulty making a moral judgment now on babies that are, say, X weeks old that we have difficulty treating. If in the future we can more easily treat X week old patients and X-1 week old patients are the ones we have more difficulty treating, I’m wondering what other dilemmas you have in mind.

We must ask ourselves the question: “Are we really meant to preserve every life, at whatever cost? Or, as Christians, are we to do what is reasonable and charitable, but know that this is not the life for which we are ultimately destined?”

Yes, I agree completely; that’s why it’s a moral dilemma. Where we draw that line may be in a different place 25 years from now.

 

[Newbie2]

They do wherever it is warranted; the problem is, the baby’s body doesn’t react to the drugs in the same way a fully developed baby would. Many of the bodily systems and functions we think of in terms of the human body just are not present. If you administer a painkiller that deadens the response of neuroreceptors, that does little good to a fetus that doesn’t have all their neuroreceptors and the chemistry systems to support them in place. Or one who’s liver/kidneys cannot withstand the toxicity of compounds formed when the drug enters the bloodstream.

Here is another example that I came to be aware of from the work of a research team that conducted some clinical tests in the NICU where my wife worked. In a fully developed human being, there are two mechanisms that allow us to breathe without conscious effort to do so. First, there is a center of the brain that “measures” (I’m using loose terminology here) the amount of oxygen in the blood flow to the brain. When it drops below a certain point, it triggers responses to muscles, diaphragm, etc. to make us take a breath. Now we can override this system if consciously trying to, such as when we swim underwater some distance. There is a second center of the brain, independent of the first, that “measures” carbon dioxide levels in the blood. This serves as the “back up” for method number 1, and this normally cannot be overridden consciously, though with specific practice it can be.

When these systems develop in a fetus, the second means develops first. That is, the carbon dioxide “sensor” develops first, some weeks before the “oxygen” sensor does. Additionally, it develops with a special characteristic that we lose somewhere in our development. That is, if the CO2 sensor causes the breath, it also shuts down, temporarily, the ability of the brain to absorb oxygen out of the blood, apparently to protect against further carbon dioxide saturation. That would mean the baby would breathe, but there would be a short delay, until the oxygenated blood actually got to the brain’s sensor and it accepted the level of CO2 as low enough to proceed, it then activates the brain’s ability to absorb gas out of the blood. I don’t know if other organs are effected in a like manner, this was just dealing with the brain.

So here is the problem. Baby is born premature, and can breathe with the “CO2” sensor only. But the baby’s lungs are so undeveloped, it has to be respirated, meaning supplied oxygen (and no CO2) by artificial means. Without some CO2, this sensor can go haywire and cause the brain to, for short periods, stop absorbing oxygen. I don’t think I need to explain what happens when brain cells get no oxygen.

What this group was searching for is the “switch” that can reliably turn brain oxygen absorption on and keep it on during this temporary, premature state.

This is just one example of how the treatment of premature babies can be the best care the world can muster, the budget can be a blank check,** but unless the developing cells of that tiny little brain cooperates, it can all be for nothing**.

That’s the question, isn’t it…is supporting such a baby until he or she can function on their own morally acceptable given all the variables and difficulties.

Good information.

 

[dixieagle]

Why would the dilemma be any different? We have difficulty making a moral judgment now on babies that are, say, X weeks old that we have difficulty treating. If in the future we can more easily treat X week old patients and X-1 week old patients are the ones we have more difficulty treating, I’m wondering what other dilemmas you have in mind.

The ethical dilemmas I foresee would surround the development of such things as “artificial wombs”, on which research has already been done (referenced earlier.)

While employing such a thing to allow a micropreemie to develop sufficiently would differ from - for example - surrogate motherhood, IVF, etc., it would raise questions as to what is moral in reproductive science and what is not. (All still quite hypothetical.)

 

[Mary_Gail_36]

The ethical dilemmas I foresee would surround the development of such things as “artificial wombs”, on which research has already been done (referenced earlier.)

While employing such a thing to allow a micropreemie to develop sufficiently would differ from - for example - surrogate motherhood, IVF, etc., it would raise questions as to what is moral in reproductive science and what is not. (All still quite hypothetical.)

Working on ways to keep the babies inside the mommies could be a possibility. When my son was born, the doctors tried delaying the birth. Maybe in the future, that could be easier. As miraculous as NICU’s are…they aren’t the womb.

Also, the debate at hand is focusing on micropreemies. I am not sure how likely they are to survive birth. Would any one know?

 

[dixieagle]

Working on ways to keep the babies inside the mommies could be a possibility. When my son was born, the doctors tried delaying the birth. Maybe in the future, that could be easier. As miraculous as NICU’s are…they aren’t the womb.

Also, the debate at hand is focusing on micropreemies. I am not sure how likely they are to survive birth. Would any one know?

Coming up with more effective means to stop labor would certainly be an enormous advance. There is research ongoing in this regard - trying to determine, at the molecular level, what triggers preterm labor. I imagine there will be great strides made in the foreseeable future.

I just saw an article about a Swedish study of extremely preterm (27 weeks or less) infants. Of them, about 70% were born alive, roughly 30% stillborn. Of those born alive, about 70% survived to their first birthdays, with an enormous leap in survival (from less than 10% to more than 50%) from 22 to 23 weeks gestational age. health.discovery.com/news/healthscout/article.html?article=627664&category=22&year=2009

Those few days between the 22nd and 23rd weeks seems to make a huge difference.

 

[centurionguard]

First, I am in not your “pal”, but a 57 year old mother.

The entire thrust of this thread is what should be done NOW with a 21-22 week micropreemie. No one has suggested that research should not continue. However, due to the problems presented by underdeveloped lungs, etc., beneath a certain threshold the only way that even tinier babies might, in the future, survive, would be through technology that would bring with it its own set of ethical dilemmas.

We must ask ourselves the question: “Are we really meant to preserve every life, at whatever cost? Or, as Christians, are we to do what is reasonable and charitable, but know that this is not the life for which we are ultimately destined?”

Monetary cost should not be a major issue of concern. We are after all taking about preserving human life with a soul in the image of God. Be it that I am not a mother or a father for that matter. My heart could only deeply sympathize what a mothers heart goes through when faced with her own preemie baby hanging to life on a thread. Where does one cross the line of being caught in the tangle of human emotions and saying good-bye to human life when you know morally that you and doctors have exhausted all talents they could, and then utimately a mother saying goodbye to the precious life she bore as a gift from God.
I think a mother has to find an incredible amount of courage with a certain quality of peace in her own heart knowing that she and medical professionals did not give up so easily saving this tiny precious life. Its regrettable that an awful lot of (“Mercy Killing”) goes on in todays hospitals. And not exclusively with the elderly. As one who once worked in the medical profession it did not go on unnoticed. In the end I think a mother who sees her preemie’s life finally expire, through some course has to come to a inner moral peaceful conclusion cognizant that she fought to do all she could with all her strength to save the life of her beloved baby.

 

[St_Francis]

I wonder what would have happened if the doctors had explained the situation differently to the mother. If they had said, look, we do not have what your baby needs. Your baby is not developed enough to survive, and we do not have the knowledge or resources to make up for that lack of development.

I mean, saying, sorry, there are rules against helping babies born so early is not really helpful to a mother because it sounds like they *could *help if only the rules weren’t in place to prevent it.

The Catholic Church does not require that extraordinary means (nutrition, hydration) be used if they are burdensome, and specifies that a financial burden counts. Life here on earth is not to be maintained at all cost; it is merely a stepping stone towards Heaven. All babies born at such an early age should be baptized, and the medical decisions made with prudence.

 

[centurionguard]

I wonder what would have happened if the doctors had explained the situation differently to the mother. If they had said, look, we do not have what your baby needs. Your baby is not developed enough to survive, and we do not have the knowledge or resources to make up for that lack of development.

I mean, saying, sorry, there are rules against helping babies born so early is not really helpful to a mother because it sounds like they *could *help if only the rules weren’t in place to prevent it.

The Catholic Church does not require that extraordinary means (nutrition, hydration) be used if they are burdensome, and specifies that a financial burden counts. Life here on earth is not to be maintained at all cost; it is merely a stepping stone towards Heaven. All babies born at such an early age should be baptized, and the medical decisions made with prudence.

I would go along with you for the most part of what you are saying, but, to a point.
I dispise the word (“burdensome”) being used to describe the attempt to save human life to the best of our abilities. Isn’t it strange how our (“Culture of Death”) in society as so appropriately parapharsed by the late Pope John Paul II; would put a monetary cost factor on human life instead of seeing every human life at all stages from the beginning of (“life through death”) as being priceless in the eyes of God. Yet; we humans prejudge everything has having a finite value of cost by the primitive reasoning faculty of human measure. Scary prospect if God judged our souls by the same human faculty of measuring the finality of everything as this or that. “Including Human Life”. Just a thought.

 

[St_Francis]

I would go along with you for the most part of what you are saying, but, to a point.
I dispise the word (“burdensome”) being used to describe the attempt to save human life to the best of our abilities. Isn’t it strange how our (“Culture of Death”) in society as so appropriately parapharsed by the late Pope John Paul II; would put a monetary cost factor on human life instead of seeing every human life at all stages from the beginning of (“life through death”) as being priceless in the eyes of God. Yet; we humans prejudge everything has having a finite value of cost by the primitive reasoning faculty of human measure. Scary prospect if God judged our souls by the same human faculty of measuring the finality of everything as this or that. “Including Human Life”. Just a thought.

No, no, that’s not what I meant. The Church mentioned other examples of burdensomeness, but I only included the financial because a lot of people know about the others: if the hardships of the treatment outweigh the potential benefits; if the benefits would not be enough, etc.

There is a big difference between letting someone die of causes which exist within him (trauma suffered in an accident, extreme illness, etc) and actually killing him. The latter is of course always wrong. However, saying that this person or oneself is in such a condition that allowing nature to take its course instead of medically intervening is not necessarily the wrong thing to do.

As humans, we have limited resources, and determining how best to use those resources is the virtue of prudence. Even if we had a single-payer system, at some point we would have to say about each person: enough. Even when it’s a rich family with lots of insurance, there is a time to say: enough.

What makes a person priceless is not his body but his *soul. *And the soul will never die.